Framework for Mass Casualty Management
and the Role of the Anesthesiologist

Anesthesiology News, May 6, 2003

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By Ernesto A. Pretto, MD, MPH

Injury or trauma may be defined as physical or psychological harm resulting from adverse environmental factors or circumstances. The terms injury and trauma can be used interchangeably, but I prefer to use the word trauma. The mechanisms of physical trauma can be classified into broad categories such as intentional or unintentional, blunt or penetrating. Intentional trauma is further subdivided into suicide (self-inflicted trauma) or homicide from violence, a major health problem in our world today. Disasters, however, constitute special emergencies characterized by mass trauma or illness, and requiring extraordinary emergency response capability. As I mentioned in the first part of this series, medical disasters can be classified into two main types: natural (e.g. earthquakes, hurricanes, etc.) or man-made (e.g. weapons of mass destruction, armed conflict, wars, and complex humanitarian emergencies, etc.). In a temporal perspective, disasters also can be classified as chronic or protracted, as in drought or war (Ethiopia 1986, Somalia 1998, Bosnia 1993), or sudden-impact, as in earthquakes or terrorism (Armenia 1988, Kobe, Japan 1995, New York 2001). Response will vary according to type.